Overview of Published Literature Identifying Clostridioides difficile Infection Health Disparities
| Study . | Population . | Outcome . | Key Findings . | P Value . |
|---|---|---|---|---|
| Freedberg et al 2013 | Single-center hospital (n = 894 CDI patients) | CDI recurrence | Black versus White race Hazard ratio, 1.66; 95% confidence interval, 1.05–2.63 | |
| Mao et al 2015 | National sample of US hospital discharges that included antibiotic exposure (n = 178 000 CDI discharges) | CDI incidence | Black race: 0.75% Asian race: 0.25% Hispanic ethnicity: 0.50% White race: 1.0%; | .001 .003 .059 .001 |
| CDI complications | Black race: 7.8% Asian race: 9.0% Hispanic ethnicity: 7.8% White race: 8.25% | 1.000 .824 .824 1.000 | ||
| Inpatient mortality | Black race: 1.0% Asian race: 0.20% Hispanic ethnicity: 1.5% White race: 1.2% | 1.000 | ||
| Argamany et al 2016 | National sample of US hospital discharges (n = 1.7 million CDI discharges) | CDI incidence | Black race: 4.9 per 1000 White race: 7.7 per 1000 | <.001 |
| Severe CDI | Black race: 24% White race: 19% | <.001 | ||
| Inpatient mortality | Black race: 7.4% White race: 7.2% | <.001 | ||
| LOS >7 days | Black race: 57% White race: 52% | <.001 | ||
| Young et al 2022 | National sample of US healthcare system (n = 45 331 CDI encounters) | Severe CDI | Black race: aOR 1.85 (1.71–2.00) Hispanic ethnicity: aOR 1.22 (1.08–1.38) | |
| Recurrent CDI | Black race: aOR 1.17 (1.03–1.34) Hispanic ethnicity: aOR 0.94 (0.76–1.17) | |||
| Inpatient mortality | Black race: aOR 0.96 (0.82–1.13) Hispanic ethnicity: aOR 0.93 (0.72–1.21) | |||
| LOS >7 days | Black race: aOR 1.29 (1.19–1.41) Hispanic ethnicity: aOR 0.89 (0.78–1.02) | |||
| Treatment costs (recurrent CDI) | Black race: $12 352, Hispanic ethnicity: $11 019 White race: $8502 | <.001 < .001 | ||
| Lee et al 2023 | Single hospital system (n = 219 CDI patients) | Severe CDI | REM: 40.0% Non-REM: 38.1% | .779 |
| Intensive care unit admission | REM: 42.2% Non-REM: 26.2%, | .016 | ||
| Inpatient mortality | REM: 10.4% Non-REM: 13.1%, | .537 | ||
| LOS >10 days | REM: 74.0% Non-REM: 32.0% | .016 | ||
| Skrobarcek et al 2021 | CDI surveillance in 10 US states (n = 9413 CA-CDI cases) | “Poverty” factor | RR: 1.19 (1.15–1.22) | .0001 |
| “Foreign-born” factor | RR: 1.05 (1.02–1.08) | <.001 | ||
| “High-income” factor | RR: 0.95 (0.92–0.97) | <.001 | ||
| Hudspeth et al 2019 | CDI surveillance in Bernalillo County, New Mexico (n = 1672 CA-CDI cases) | >20% no health insurance | Incidence rate ratio: 1.718 (1.4–2.108) | <.001 |
| CDI incidence | White women: Reference Black women: 5.98 (3.379–10.567) Asian race: 9.353 (5.444–16.067) White men: Reference Black men: 27.681 (12.931–59.256) American Indian/Alaskan Native men: 11.657 (5.781–23.507) | <.001 <.001 <.001 <.001 |
| Study . | Population . | Outcome . | Key Findings . | P Value . |
|---|---|---|---|---|
| Freedberg et al 2013 | Single-center hospital (n = 894 CDI patients) | CDI recurrence | Black versus White race Hazard ratio, 1.66; 95% confidence interval, 1.05–2.63 | |
| Mao et al 2015 | National sample of US hospital discharges that included antibiotic exposure (n = 178 000 CDI discharges) | CDI incidence | Black race: 0.75% Asian race: 0.25% Hispanic ethnicity: 0.50% White race: 1.0%; | .001 .003 .059 .001 |
| CDI complications | Black race: 7.8% Asian race: 9.0% Hispanic ethnicity: 7.8% White race: 8.25% | 1.000 .824 .824 1.000 | ||
| Inpatient mortality | Black race: 1.0% Asian race: 0.20% Hispanic ethnicity: 1.5% White race: 1.2% | 1.000 | ||
| Argamany et al 2016 | National sample of US hospital discharges (n = 1.7 million CDI discharges) | CDI incidence | Black race: 4.9 per 1000 White race: 7.7 per 1000 | <.001 |
| Severe CDI | Black race: 24% White race: 19% | <.001 | ||
| Inpatient mortality | Black race: 7.4% White race: 7.2% | <.001 | ||
| LOS >7 days | Black race: 57% White race: 52% | <.001 | ||
| Young et al 2022 | National sample of US healthcare system (n = 45 331 CDI encounters) | Severe CDI | Black race: aOR 1.85 (1.71–2.00) Hispanic ethnicity: aOR 1.22 (1.08–1.38) | |
| Recurrent CDI | Black race: aOR 1.17 (1.03–1.34) Hispanic ethnicity: aOR 0.94 (0.76–1.17) | |||
| Inpatient mortality | Black race: aOR 0.96 (0.82–1.13) Hispanic ethnicity: aOR 0.93 (0.72–1.21) | |||
| LOS >7 days | Black race: aOR 1.29 (1.19–1.41) Hispanic ethnicity: aOR 0.89 (0.78–1.02) | |||
| Treatment costs (recurrent CDI) | Black race: $12 352, Hispanic ethnicity: $11 019 White race: $8502 | <.001 < .001 | ||
| Lee et al 2023 | Single hospital system (n = 219 CDI patients) | Severe CDI | REM: 40.0% Non-REM: 38.1% | .779 |
| Intensive care unit admission | REM: 42.2% Non-REM: 26.2%, | .016 | ||
| Inpatient mortality | REM: 10.4% Non-REM: 13.1%, | .537 | ||
| LOS >10 days | REM: 74.0% Non-REM: 32.0% | .016 | ||
| Skrobarcek et al 2021 | CDI surveillance in 10 US states (n = 9413 CA-CDI cases) | “Poverty” factor | RR: 1.19 (1.15–1.22) | .0001 |
| “Foreign-born” factor | RR: 1.05 (1.02–1.08) | <.001 | ||
| “High-income” factor | RR: 0.95 (0.92–0.97) | <.001 | ||
| Hudspeth et al 2019 | CDI surveillance in Bernalillo County, New Mexico (n = 1672 CA-CDI cases) | >20% no health insurance | Incidence rate ratio: 1.718 (1.4–2.108) | <.001 |
| CDI incidence | White women: Reference Black women: 5.98 (3.379–10.567) Asian race: 9.353 (5.444–16.067) White men: Reference Black men: 27.681 (12.931–59.256) American Indian/Alaskan Native men: 11.657 (5.781–23.507) | <.001 <.001 <.001 <.001 |
Abbreviations: aOR, adjusted odds ratio; CA-CDI, community-associated Clostridioides difficile infection; CDI, Clostridioides difficile infection; LOS, hospital length of stay; REM, persons from racial or ethnic minority groups; RR, relative risk.
Overview of Published Literature Identifying Clostridioides difficile Infection Health Disparities
| Study . | Population . | Outcome . | Key Findings . | P Value . |
|---|---|---|---|---|
| Freedberg et al 2013 | Single-center hospital (n = 894 CDI patients) | CDI recurrence | Black versus White race Hazard ratio, 1.66; 95% confidence interval, 1.05–2.63 | |
| Mao et al 2015 | National sample of US hospital discharges that included antibiotic exposure (n = 178 000 CDI discharges) | CDI incidence | Black race: 0.75% Asian race: 0.25% Hispanic ethnicity: 0.50% White race: 1.0%; | .001 .003 .059 .001 |
| CDI complications | Black race: 7.8% Asian race: 9.0% Hispanic ethnicity: 7.8% White race: 8.25% | 1.000 .824 .824 1.000 | ||
| Inpatient mortality | Black race: 1.0% Asian race: 0.20% Hispanic ethnicity: 1.5% White race: 1.2% | 1.000 | ||
| Argamany et al 2016 | National sample of US hospital discharges (n = 1.7 million CDI discharges) | CDI incidence | Black race: 4.9 per 1000 White race: 7.7 per 1000 | <.001 |
| Severe CDI | Black race: 24% White race: 19% | <.001 | ||
| Inpatient mortality | Black race: 7.4% White race: 7.2% | <.001 | ||
| LOS >7 days | Black race: 57% White race: 52% | <.001 | ||
| Young et al 2022 | National sample of US healthcare system (n = 45 331 CDI encounters) | Severe CDI | Black race: aOR 1.85 (1.71–2.00) Hispanic ethnicity: aOR 1.22 (1.08–1.38) | |
| Recurrent CDI | Black race: aOR 1.17 (1.03–1.34) Hispanic ethnicity: aOR 0.94 (0.76–1.17) | |||
| Inpatient mortality | Black race: aOR 0.96 (0.82–1.13) Hispanic ethnicity: aOR 0.93 (0.72–1.21) | |||
| LOS >7 days | Black race: aOR 1.29 (1.19–1.41) Hispanic ethnicity: aOR 0.89 (0.78–1.02) | |||
| Treatment costs (recurrent CDI) | Black race: $12 352, Hispanic ethnicity: $11 019 White race: $8502 | <.001 < .001 | ||
| Lee et al 2023 | Single hospital system (n = 219 CDI patients) | Severe CDI | REM: 40.0% Non-REM: 38.1% | .779 |
| Intensive care unit admission | REM: 42.2% Non-REM: 26.2%, | .016 | ||
| Inpatient mortality | REM: 10.4% Non-REM: 13.1%, | .537 | ||
| LOS >10 days | REM: 74.0% Non-REM: 32.0% | .016 | ||
| Skrobarcek et al 2021 | CDI surveillance in 10 US states (n = 9413 CA-CDI cases) | “Poverty” factor | RR: 1.19 (1.15–1.22) | .0001 |
| “Foreign-born” factor | RR: 1.05 (1.02–1.08) | <.001 | ||
| “High-income” factor | RR: 0.95 (0.92–0.97) | <.001 | ||
| Hudspeth et al 2019 | CDI surveillance in Bernalillo County, New Mexico (n = 1672 CA-CDI cases) | >20% no health insurance | Incidence rate ratio: 1.718 (1.4–2.108) | <.001 |
| CDI incidence | White women: Reference Black women: 5.98 (3.379–10.567) Asian race: 9.353 (5.444–16.067) White men: Reference Black men: 27.681 (12.931–59.256) American Indian/Alaskan Native men: 11.657 (5.781–23.507) | <.001 <.001 <.001 <.001 |
| Study . | Population . | Outcome . | Key Findings . | P Value . |
|---|---|---|---|---|
| Freedberg et al 2013 | Single-center hospital (n = 894 CDI patients) | CDI recurrence | Black versus White race Hazard ratio, 1.66; 95% confidence interval, 1.05–2.63 | |
| Mao et al 2015 | National sample of US hospital discharges that included antibiotic exposure (n = 178 000 CDI discharges) | CDI incidence | Black race: 0.75% Asian race: 0.25% Hispanic ethnicity: 0.50% White race: 1.0%; | .001 .003 .059 .001 |
| CDI complications | Black race: 7.8% Asian race: 9.0% Hispanic ethnicity: 7.8% White race: 8.25% | 1.000 .824 .824 1.000 | ||
| Inpatient mortality | Black race: 1.0% Asian race: 0.20% Hispanic ethnicity: 1.5% White race: 1.2% | 1.000 | ||
| Argamany et al 2016 | National sample of US hospital discharges (n = 1.7 million CDI discharges) | CDI incidence | Black race: 4.9 per 1000 White race: 7.7 per 1000 | <.001 |
| Severe CDI | Black race: 24% White race: 19% | <.001 | ||
| Inpatient mortality | Black race: 7.4% White race: 7.2% | <.001 | ||
| LOS >7 days | Black race: 57% White race: 52% | <.001 | ||
| Young et al 2022 | National sample of US healthcare system (n = 45 331 CDI encounters) | Severe CDI | Black race: aOR 1.85 (1.71–2.00) Hispanic ethnicity: aOR 1.22 (1.08–1.38) | |
| Recurrent CDI | Black race: aOR 1.17 (1.03–1.34) Hispanic ethnicity: aOR 0.94 (0.76–1.17) | |||
| Inpatient mortality | Black race: aOR 0.96 (0.82–1.13) Hispanic ethnicity: aOR 0.93 (0.72–1.21) | |||
| LOS >7 days | Black race: aOR 1.29 (1.19–1.41) Hispanic ethnicity: aOR 0.89 (0.78–1.02) | |||
| Treatment costs (recurrent CDI) | Black race: $12 352, Hispanic ethnicity: $11 019 White race: $8502 | <.001 < .001 | ||
| Lee et al 2023 | Single hospital system (n = 219 CDI patients) | Severe CDI | REM: 40.0% Non-REM: 38.1% | .779 |
| Intensive care unit admission | REM: 42.2% Non-REM: 26.2%, | .016 | ||
| Inpatient mortality | REM: 10.4% Non-REM: 13.1%, | .537 | ||
| LOS >10 days | REM: 74.0% Non-REM: 32.0% | .016 | ||
| Skrobarcek et al 2021 | CDI surveillance in 10 US states (n = 9413 CA-CDI cases) | “Poverty” factor | RR: 1.19 (1.15–1.22) | .0001 |
| “Foreign-born” factor | RR: 1.05 (1.02–1.08) | <.001 | ||
| “High-income” factor | RR: 0.95 (0.92–0.97) | <.001 | ||
| Hudspeth et al 2019 | CDI surveillance in Bernalillo County, New Mexico (n = 1672 CA-CDI cases) | >20% no health insurance | Incidence rate ratio: 1.718 (1.4–2.108) | <.001 |
| CDI incidence | White women: Reference Black women: 5.98 (3.379–10.567) Asian race: 9.353 (5.444–16.067) White men: Reference Black men: 27.681 (12.931–59.256) American Indian/Alaskan Native men: 11.657 (5.781–23.507) | <.001 <.001 <.001 <.001 |
Abbreviations: aOR, adjusted odds ratio; CA-CDI, community-associated Clostridioides difficile infection; CDI, Clostridioides difficile infection; LOS, hospital length of stay; REM, persons from racial or ethnic minority groups; RR, relative risk.
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